RESUMO
JUSTIFICATIVA E OBJETIVOS: Apresenta-se neste relato de caso uma complicação muito rara após a anestesia espinhal, com o objetivo de oferecer algum subsídio ao manuseio e à conduta terapêutica. RELATO DO CASO: Paciente de 63 anos, negro, ASA I, programado para a ressecção transuretral da próstata (RTU), foi submetido a uma anestesia subaracnoidea com bupivacaína (15 mg) sem adrenalina. A punção não apresentou intercorrências e o paciente foi posicionado para cirurgia. Logo após o posicionamento cirúrgico, o paciente reclamou de dor intensa na região perineal, acompanhada de movimentos involuntários, tipo contrações tônico-clônicas, nos membros inferiores. O paciente recebeu benzodiazepínico para controle das mioclonias, sem resultado. Em seguida, o paciente apresentou agitação importante e, submetido à intubação orotraqueal, foi mantido em ventilação controlada e encaminhado para a Unidade de Cuidados Intensivos. Apesar da realização de todos os exames bioquímicos e de imagem, nenhuma causa aparente foi detectada. Não houve troca de medicação e o mesmo lote de anestésico havia sido usado em outros pacientes naquele dia, sem intercorrências. CONCLUSÕES: Com o afastamento de todas as causas possíveis, foi aceito, por exclusão, o diagnóstico de mioclonia espinhal pós-raquianestesia com bupivacaína.
BACKGROUND AND OBJECTIVES: It is presented in this case report a very rare complication after spinal anesthesia to provide subsidies to the management and therapeutic conduct. CASE REPORT: This is a 63-year old African-Brazilian patient, ASA I, scheduled for transurethral resection of the prostate (TURP). He underwent subarachnoid anesthesia with bupivacaine (15 mg) without adrenaline. Intercurrences were not observed during puncture, and the patient was positioned for surgery. Soon after positioning the patient, he complained of severe pain in the perineum region followed by involuntary tonic-clonic movements of the lower limbs. The patient was treated with a benzodiazepine to control the myoclonus without response. This episode was followed by significant agitation and the patient was intubated. He was maintained in controlled ventilation and transferred to the Intensive Care Unit. Despite all biochemical and imaging tests performed, an apparent cause was not detected. The medication was not changed and the same batch of anesthetic had been used in other patients that same day without intercurrences. CONCLUSIONS: After ruling out all possible causes, the diagnosis of spinal myoclonus after spinal anesthesia with bupivacaine was made by exclusion.
JUSTIFICATIVA Y OBJETIVOS: En este relato de caso, presentamos una complicación muy rara después de la anestesia espinal, con el objetivo de ofrecer algún subsidio para el manejo y la conducta terapéutica. RELATO DEL CASO: Paciente de 63 años, negro, ASA I, programado para la resección transuretral de la próstata (RTU), que fue sometido a una anestesia subaracnoidea con bupivacaína (15 mg), sin adrenalina. La punción no presentó intercurrencias y el paciente fue posicionado para la cirugía. Inmediatamente después del posicionamiento quirúrgico, el paciente se quejó de un intenso dolor en la región perineal, seguido de movimientos involuntarios, como contracciones tónico-clónicas en los miembros inferiores. El paciente recibió benzodiazepínico para el control de las mioclonías, sin resultados. Enseguida, debutó con una agitación importante y fue sometido a la intubación orotraqueal y mantenido bajo ventilación controlada. Posteriormente fue derivado a la Unidad de Cuidados Intensivos. A pesar de la realización de todos los exámenes bioquímicos y de imagen, no se detectó ninguna causa aparente. No hubo cambio de medicación y se usó el mismo lote de anestésico que había sido usado en otros pacientes aquel día, sin intercurrencias. CONCLUSIONES: Al descartar todas las posibles causas, se aceptó, por exclusión, el diagnóstico de la mioclonía espinal postraquianestesia con bupivacaína.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Mioclonia/complicações , Mioclonia/etiologia , Mioclonia/fisiopatologia , Raquianestesia/efeitos adversosRESUMO
BACKGROUND AND OBJECTIVES: It is presented in this case report a very rare complication after spinal anesthesia to provide subsidies to the management and therapeutic conduct. CASE REPORT: This is a 63-year old African-Brazilian patient, ASA I, scheduled for transurethral resection of the prostate (TURP). He underwent subarachnoid anesthesia with bupivacaine (15 mg) without adrenaline. Intercurrences were not observed during puncture, and the patient was positioned for surgery. Soon after positioning the patient, he complained of severe pain in the perineum region followed by involuntary tonic-clonic movements of the lower limbs. The patient was treated with a benzodiazepine to control the myoclonus without response. This episode was followed by significant agitation and the patient was intubated. He was maintained in controlled ventilation and transferred to the Intensive Care Unit. Despite all biochemical and imaging tests performed, an apparent cause was not detected. The medication was not changed and the same batch of anesthetic had been used in other patients that same day without intercurrences. CONCLUSIONS: After ruling out all possible causes, the diagnosis of spinal myoclonus after spinal anesthesia with bupivacaine was made by exclusion.
